> The insurance-based system is the reason these costs are so high in the US and lower elsewhere.
No, that can't explain it, because it's also lower in other places that use a mixed public/private system with mandatory insurance purchase and public fallback for the medically indigent, instead of a single buyer.
Food for thought... Japan also has private insurance/providers, mostly through employers, just like the US. But they have half our cost, universal coverage, and better outcomes. Why? The big difference is that Japan has strict price controls. Insurers and providers don't negotiate with each other (in network vs out of network in the US). Prices are set to make sure providers and insurers are both profitable but not profiteering.
Of course, such an idea here would be seen as straight-up Marxism.
Capitalism is such a core part of the ethos of the United States that we believe it is the best answer for all problems. Problem is, healthcare is about as inelastic a market as you can have.
I really think we might be close to the tipping point now. Plenty of people on both sides of the great political divide are starting to appreciate that no matter what we try, health costs continue to spiral out of control. That and the hard core folks are starting to die off.
This is why I think a lot of people on the left are misguided in their commitment to single payer solutions. They're putting means ahead of ends. It's perfectly feasible to get universal coverage and sane costs, while preserving the existing insurance/provider model - thus minimizing political resistance from both the industry and the socialism-phobic public.
There's something uniquely pathological about the US system to lead to costing about twice as much as any other industrialized nation per capita, while leaving millions uninsured, causing hundreds of thousands of bankruptcies per year (even if insured), and frankly having pretty crap outcomes. It's not just that we need a system that would be better... it's that it's hard to imagine a system actually being worse, if one is being realistic and not merely partisan.
Another thing toxifying the discourse is American Exceptionalism, that underlying believe that America is better than everyone else at everything. It's hard for a lot of people to even admit that our system isn't the best. There's a lot of "Yeah, it's expensive, but look at our technology!" I don't really know how to argue against the Exceptionalism argument.
> It's perfectly feasible to get universal coverage and sane costs, while preserving the existing insurance/provider model
Okay, but how? I have 'good' insurance and it still blows.
My most recent example -- I had a Holter monitor for a day and I paid 50% more for the 24 hour usage of that monitor than I can buy it for brand new. And then I paid $350 for a technician to tell my cardiologist how many events were recorded (being as optimistic as possible, that most likely involved verifying that the machine counted correctly).
Contrast that to a couple weeks prior in Hyderabad India, I went to the local CARE Hospital, which is actually a precent decent place -- the equipment was state of the art, and I did not interact with technicians, but actual doctors. Had an echocardiogram done by an actual doctor, consulted with another cardiologist, as well as an electrophysiologist. Total cost? 4400 INR. Do that math on that one.
I definitely expect the costs to be lower in India for obvious reasons, but the dichotomy is nuts.
> It's perfectly feasible to get universal coverage and sane costs, while preserving the existing insurance/provider model - thus minimizing political resistance from both the industry and the socialism-phobic public.
Single-payer has had more public support (usually majority public support) than other routes to universal healthcare all the way back to and before when Bill Clinton campaigned heavily on health care reform in 1992; Democrats keep putting up complex, unpopular insurance industry kickback schemes instead, which end up easing Republicans effort to kill them either in advance of implementation (as with Clinton's effort) or afterwards (as with the ACA's progressive dismantlement since Obama left office.)
Be careful not to assume that implementation is much simpler than it actually is. Oversimplification is a political problem for both right and left when it comes to health care.
Also, definitely avoid conspiracy theory thinking that Democrats wound up with ACA rather than "single payer" out of corruption and malice, rather than realistic political consideration. That's another pathology. I don't believe there are any Democratic politicians who want health care to be more expensive and difficult! They want cheap, universal, quality, and fair. Duh.
No, that can't explain it, because it's also lower in other places that use a mixed public/private system with mandatory insurance purchase and public fallback for the medically indigent, instead of a single buyer.